|Bowel Prep. | Liver Biopsy Instructions | Flexible Proctosigmoidoscopy | Fleet's Phospho-Soda Bowel Prep | Prep for EGD-ERCP-PEG|
GLYCOLAZ BOWEL PREARATION FOR COLONOSCOPY
The purpose of the following instructions is to provide good bowel preparation prior to colonoscopy to enhance the quality and safety of the examination. Failure to comply with these instructions may result in having to repeat the bowel Preparation and reattempt colonoscopy at a later date. If questions arise regarding the bowel preparation please do not hesitate to contact the office and resolve these.
On ___________________only clear liquids may be taken for breakfast, lunch and dinner (clear liquids include: water, coffee, tea, soda pop, clear fruit juice apple, grape, cranberry; bouillon, plain jell-o, Gatorade. NO SOLID FOODS, MILK OR MILK PRODUCTS ALLOWED. NOTHING RED.
On ___________________at_________________ take 4 bisacodyl tablets with 8 oz. of water.
On ___________________at_________________ take one reglan 10 mg. tablet. Start Glycolax preparation at ______. Dissolve entire 255 gm. bottle of Glycolax in 2 quarts (8 coups) of clear liquid of your choice. Drink one (8 oz.) glass every 15 minutes until the 2 quarts are completely gone. This will take 2 hours to complete
Only drink clear liquids until ___________________________________. IF YOU TAKE HEART, LUNG, OR BLOOD PRESSURE MEDICATION IN THE MORNING, PLEASE BE SURE TO TAKE YOUR MEDICATION BEFORE YOU COME TO THE HOSPITAL/ENDO CENTER.
Appear for examination at _____________________________________.
NOTE: IF YOU CANCEL YOUR PROCEDURE WITHIN 24 HOURS OF SCHEDULED TIME, YOU WILL
BE CHARGED $100 00
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